Clinical Aspects Research Articles

Clinical and diagnostic aspects of cervical ectopia associated with sexually transmitted infections in young unborn women

Relevance. The prevalence of cervical ectopia varies from 17 to 59%. Cervical ectopia is diagnosed in 54.2% young women under 25 years of age. It is most often diagnosed during preventive examinations. Cervical ectopia is considered a variant of the normal histophysiological condition of the cervix. At the same time, it has been proven that in ectopia, the cylindrical epithelium with its crypts is the main and ideal place for the introduction of sexually transmitted infections. The complicated course of ectopia against the background of the inflammatory process is observed in 67.7-71.2% cases, contributes to the disruption of epithelial proliferation processes and can lead to the development of dysplasia and cellular atypism.Aim. To analyze the literary sources devoted to cervical ectopia associated with sexually transmitted infections in young unborn women.Materials and methods. The literary review and analysis of publications on the topic in sources indexed in e-Library, Google Academy, Pubmed databases. The keywords to search were cervical ectopia, human papillomavirus, and pathology of the uterus. The inclusion criteria were the reports on randomized and cohort studies conducted on large populations, meta-analyses and systematic reviews, original full-text articles in English and Russian, which are publicly available and contain statistically confirmed conclusions. The exclusion criteria were summary reports, newspaper articles and personal messages. The result of the relevant search was 1,200 articles, and 32 articles were selected for final analysis.Results and discussion. The results showed that cervical ectopia associated with sexually transmitted infections, especially papillomavirus infection, occurs with high frequency among women of young reproductive age, which accordingly increases the risk of cervical cancer developing.Conclusion. Thus, cervical ectopia is common among young women and adolescents, and is almost always associated with sexually transmitted infections.

ALOPECIA X IN GERMAN SPITZ RESPONSIVE TO ORCHIECTOMY ASSOCIATED WITH THE USE OF MELATONIN: CASE REPORT

Alopecia X is a dermatological disorder that mainly affects Nordic breed dogs. Its cause is not completely clear. Alopecia X is characterized by its non-inflammatory aspect, being similar to endocrine-based dermatopathies. The main lesions are progressive hair loss in the affected areas, being less pronounced on the head and distal extremities of the limbs in more advanced cases. This study aims to report a case of alopecia X in a male, uncastrated German Spitz dog. At the first visit, an initial case of bilateral symmetrical alopecia was observed on the caudal side of the thighs and perineum, without pruritus, macroscopic signs of inflammation and clinical signs of systemic diseases. The patient underwent additional tests (including trichogram, skin scraping, direct ectoparasite screening and blood profile) in which parasitic and systemic diseases were ruled out. Based on clinical aspects, racial predisposition and exclusion of systemic causes, the diagnosis of alopecia X was considered. The treatment of choice was orchiectomy associated with the use of Melatonin, initially for 3 months. After 90 days of treatment, partial regrowth of the alopecic areas was observed, as well as a reduction in the area without hair, with return of primary and secondary hairs in the affected region. It is concluded in this case that the choice of orchiectomy associated with the use of melatonin was effective in improving the dermatological condition, and can be used as an ally in the

The Importance of Implementation of Social and Behavioral Sciences in Undergraduate Medical Education

Medical education has traditionally focused on healthcare's biological and clinical aspects, often overlooking the critical role of social and behavioral sciences. However, as the field of medicine evolves, there is a growing recognition that these disciplines are essential in cultivating well-rounded and socially conscious physicians. Integrating social and behavioral sciences into medical education offers numerous benefits that significantly enhance the development of future healthcare providers. Firstly, it fosters a more holistic understanding of patient care by emphasizing the influence of social determinants on health outcomes, which ultimately leads to improved medical practices tailored to diverse populations. Furthermore, students equipped with knowledge of behavioral sciences are better prepared to engage effectively with patients, employing communication techniques that build trust and facilitate adherence to treatment plans. This interdisciplinary approach also promotes critical thinking and problem-solving skills, as students learn to analyze complex interactions between biological, psychological, and social factors affecting health. Moreover, early exposure to these principles cultivates empathy and cultural competency, essential attributes in a rapidly diversifying patient demographic. As a result, integrating social and behavioral sciences not only enriches the educational experience but also contributes to the production of more competent and compassionate physicians. Thus, this review article aims to explore the significance of integrating social and behavioral sciences into medical education.

Telehomecare Monitoring for Patients Receiving Anticancer Oral Therapy: Protocol for a Mixed Methods Evaluability Study.

Telehomecare monitoring (TM) in patients with cancer is a complex intervention. Research shows variations in the benefits and challenges TM brings to equitable access to care, the therapeutic relationship, self-management, and practice transformation. Further investigation into these variations factors will improve implementation processes and produce effective outcomes. This study aims to concurrently analyze implementation and evaluate the effectiveness of TM for patients receiving anticancer oral therapy. The objectives are to (1) contextualize how and why TM is implemented according to (a) site characteristics, (b) team characteristics, and (c) characteristics of patients receiving anticancer oral therapy; (2) assess TM effectiveness for recording electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) according to the site, implementation process, and patient characteristics; (3) describe the acceptability and feasibility of TM from the perspectives of the people directly or indirectly involved and provide evidence-based actionable guidance in anticipation of provincewide implementation. This type II hybrid effectiveness-implementation study uses a concurrent mixed methods design. Evaluability assessment is integrated into an emerging practice in 3 participating sites to enable the evaluation of implementation strategies on TM clinical outcomes. Quantitative data for ePROMs and ePREMs will be collected using validated oncology questionnaire. Descriptive statistics and repeated measures using multiple linear mixed models and generalized estimating equations analyses will be undertaken alongside interpretive descriptive coding of qualitative data. Qualitative data will be gathered from key informants guided by the RE-AIM (reach, efficacy, adoption, implementation, maintenance) framework and its extension, PRISM (practical robust implementation and sustainability model). The concurrent approach allows results at multiple stages of this study to be integrated iteratively. The methodological choice aims to provide real-world data that are rigorous, rapidly usable in practice, and transferable to other settings. Questionnaires were pretested and the technological platform was codeveloped with members of the cancer care team and patients. Preparatory work was carried out to configure the TM platform and activate coordinating mechanisms between members of the cancer care team, patients, information technology experts, and the research team. A steering committee with 3 working groups was established to oversee the technological, clinical, and evaluation aspects of this study. Recruitment of patients for ePROMs started in February 2024, and data collection is expected to continue until March 2025. Interviews with members of the cancer care team began in November 2024. Full analysis should be completed by September 2025. This study will clarify how, why, for whom, and under what conditions TM can complement current care models. Our evaluability assessment will help to address implementation complexities and better understand intervention-to-practice operationalization so that implementation might be adapted to contextual factors without potentially harmful or inequitable impacts on patients. DERR1-10.2196/63099.

The clinical observation of none-promyelocytic AML patients inducted with idarubicin or daunorubicin included standard regimens: a tertiary care center experience

BackgroundFew Chinese study compared the impacts of idarubicin and daunorubicin based “3+7” intensive chemotherapies on early and long-term outcomes of AML patients through exploring their real-world data.Patients and methodsOur none promyelocytic AML patients inducted with “3+7” regimens were studied to find out the factors relating with induction response and long term survival.ResultsIdarubicin induction was related with less chemotherapy refractory rate comparing with daunorubicin induction (10% vs 25%, P = 0.02). But cytogenetic molecular risk classification was the only independent factor relating with achieving CR after initial induction or chemotherapy refractory (P = 0.000 and 0.036). Both to overall survival (OS) and progress free survival (PFS), having transplantation and chemotherapy refractory were independent factors related, MLL rearrangement and DNA methylating related genes’ mutations as well. CR at time of transplantation and MLL rearrangement were independent factors relating both with OS after transplantation and relapse free survival after transplantation.ConclusionTraditional “3+7” chemotherapy regimen with idarubicin plays better in CR induction than that with daunorubicin. But the patient’s long-term survival related with clinical practice aspects, like having stem cell transplantation, as well as genetic alterations equally, like MLL rearrangement and DNA methylating related genes’ mutations.

Implementation of artificial intelligence approaches in oncology clinical trials: A systematic review.

There is a growing interest in leveraging artificial intelligence (AI) technologies to enhance various aspects of clinical trials. The goal of this systematic review is to assess the impact of implementing AI approaches on different aspects of oncology clinical trials. Pertinent keywords were used to find relevant articles published in PubMed, Scopus, and Google Scholar databases, which described the clinical application of AI approaches. A quality evaluation utilizing a customized checklist specifically adapted was conducted. This study is registered with PROSPERO (CRD42024537153). Out of the identified 2833 studies, 72 studies satisfied the inclusion criteria. Clinical Trial Enrollment & Eligibility were among the most commonly studied clinical trial aspects with 30 papers. The prediction of outcomes was covered in 25 studies of which 15 addressed the prediction of patients' survival and 10 addressed the prediction of drug outcomes. The trial design was studied in 10 articles. Three studies addressed each of the personalized treatments and decision-making, while one addressed data management. The results demonstrate using AI in cancer clinical trials has the potential to increase clinical trial enrollment, predict clinical outcomes, improve trial design, enhance personalized treatments, and increase concordance in decision-making. Additionally, automating some areas and tasks, clinical trials were made more efficient, and human error was minimized. Nevertheless, concerns and restrictions related to the application of AI in clinical studies are also noted. AI tools have the potential to revolutionize the design, enrollment rate, and outcome prediction of oncology clinical trials.

Effects of Carbon Dioxide Therapy on Skin Wound Healing.

Promoting rapid healing is a concern in skin wound treatment, as the increased pain and the loss of functional ability when wounds become chronic create a complex problem to manage. This scoping review aimed to explore the literature and synthesize existing knowledge on the therapeutic use of CO2 in treating cutaneous wounds. The literature was selected using previously defined inclusion and exclusion criteria, and 22 articles were selected for data extraction. The most researched type of injury was chronic wounds located on the extremities of the limbs. Carboxytherapy was performed in five different ways: subcutaneous, intradermal, or intralesional injections; in hot water baths with temperatures ranging from 30 to 42 °C; transcutaneous application; intra-abdominal insufflation; and a paste for transcutaneous local application. The main effects of CO2 therapy described were as follows: improved blood flow and local oxygenation, reduction of the inflammatory process, increased collagen production, and improved clinical aspects of wounds, with faster healing. Carboxytherapy can be considered a good alternative for treating skin wounds, although further studies should be pursued to elucidate its molecular mechanisms and enhance its efficacy.

Marginal mandibular branch of the facial nerve - anatomical peculiarities and clinical aspects.

The expanding number of parotid ablations, reconstructive and aesthetic surgeries of the head and neck, considerably increased the risk of the marginal mandibular branch (MMB) injury. The purpose of our study was to determine the anatomical peculiarities of the MMB depending on the facial nerve branching pattern (FNBP), gender and cephalometric type. The MMB was dissected on 75 hemiheads of adult embalmed cadavers. The origin, number of branches, topography and connections of the MMB were analyzed. Seven FNBP were identified: Type I (18.7%); Type II (14.7%); Type III (20%); Type IV (14.6%); Type V (5.3%); Type VI (18.7%); Type NI (8%, non-identified types). In males 1-3 MMB were determined and in females 1-4 MMB; p = 0.845. In males, bilaterally were identified 1-3 MMB. In females on the right side were found 1-2 MMB and on the left - 1-4 MMB; p = 0.204. A single MMB was revealed in 41 cases (54.7%), 2 MMB - in 29 cases (38.7%), 3 MMB - in 4 cases (5.3%) and in a single case 4 MMB (1.3%) were determined. Depending on the FNBP, the number of the MMB was: Type I - 1.2 ± 0.43; Type II - 1.5 ± 0.52; Type III - 1.6 ± 0.63; Type IV - 1.5 ± 0.52; Type V - 1.3 ± 0.50; Type VI - 1.9 ± 0.95; Type NI - 1.7 ± 0.82. IGFV = 1.403 (intergroup frequency variation); df = 6 (degree of freedom); p = 0.226. According to the cephalometric type the number of the MMB in mesocephalic type (MCT) was 1.5 ± 0.68; in brachycephalic type (BCT) - 1.6 ± 0.52; in dolichocephalic type (DCT) - 1.9 ± 0.60. IGFV = 1.698; df = 2; p = 0.190. A rare variant of the MMB origin from the temporofacial division of the facial nerve was highlighted in 5.3% of cases. The MMB varies depending on the FNBP, gender and cephalometric type. The highest variation degree was characteristic of females, Type VI and DCT. The lowest variation degree was determined in Type I and in MCT, without gender differences. The risk of iatrogenic lesions of the MMB is conditioned by two important aspects: its anatomical variability and large number of surgical interventions at that level.

Clinical and economic aspects of chronic cerebral ischemia treatment

Clinical and economic aspects of chronic cerebral ischemia treatment

Toscana virus: A comprehensive review of 1381 cases showing an emerging threat in the Mediterranean regions.

Toscana virus (TOSV) is a sand fly-borne phlebovirus causing central nervous system (CNS) infection in Mediterranean countries, during summer season. However, clinical aspects of the disease caused by this virus are poorly known by clinicians, so that its prevalence is probably underestimated due to a lack of diagnosis. The data was gathered from all available case series and retrospective studies identifying TOSV as the causative viral agent. The informations of age, sex, clinical characteristics, laboratory findings, imaging results and clinical outcomes of TOSV infection were recorded and analyzed. A total of 95 articles including TOSV infections resulting in a total of 1381 cases, were analyzed. Our findings indicatethat TOSV affects individuals across various age groups, with a median age of 44.45 years. A notable disparity in infection rates between genders, with men being significantly more likely to present symptoms due to TOSV than women, with a sex ratio of 2.0. The clinical presentation of TOSV infection encompasses a range of symptoms, including fever, headache, retro-orbital pain, neurological and muscular manifestations with less common reports of cutaneous and gastrointestinal symptoms. To date, six fatalities have been attributed to TOSV infections, with a median age of 76 years. Diagnostic evaluation of TOSV infections often involves the analysis of cerebrospinal fluid, where findings may include an elevated white blood cell count. These findings underscore the diverse clinical manifestations of TOSV infections including flu like symtomps. TOSV is an emerging infectious threat that warrants inclusion in the diagnostic protocols for patients presenting with CNS, particularly within the Mediterranean basin or for those with recent travel history to endemic regions during warmer months when sand flies are actively circulating.

Tuberous sclerosis complex-associated kidney disease in children.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder which can have manifestations in the kidneys, along with other organ systems. Children with TSC may develop kidney lesions at any point during childhood, and typically these are angiomyolipomata (AML) and/or kidney cysts. Children may also have hypertension associated with TSC-associated kidney disease, and rarely reduced kidney function. New guidelines for the management of TSC-associated kidney disease in children and adults were published in 2024. This educational review summarises the relevant clinical aspects of these guidelines for paediatric nephrologists through a series of four clinical cases. These cases cover management of hypertension, frequency of follow-up and frequency of kidney imaging. Difficult clinical scenarios are reviewed, such as the management of TSC2-PKD1 contiguous gene syndrome and the management of large AMLs in children with TSC.

Situational Factors Impacting Harmful Behavior Towards Others Related to Mental Health in the Community and Their Associations: A Scoping Review Based on Systematic Reviews.

This study aimed to identify factors associated with harmful behavior toward others based on existing research. This scoping review focused on individuals at risk of harming others due to mental health issues, with the target population encompassing three settings: the community, inpatient facilities with frequent admissions and discharges, and healthcare settings where medical treatment is sought. A scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The terms violence, aggression, problem behavior, and workplace violence were used to search for related literature, subsequently selecting systematic reviews. A total of 24 papers were ultimately included. From the included papers, background factors (demographic, personal history, and clinical aspects); situational factors (social connection status, daily life status); psychological factors; antecedents of harmful behavior; and triggers of harmful behavior were extracted as factors associated with harmful behavior. Our results indicate that background and situational factors lead to harmful behavior toward others, disruptions in the harmony between these factors cause disturbances in psychological processes, and harmful behavior toward others is triggered by stimuli that promote such behavior. Considering that all studies reviewed herein involved inpatients and forensic patients in medical settings, further research is required to identify the factors associated with harmful behaviors occurring in the community.

Natural biomaterials in the management of the aortic valve pathology. Biomedical and clinical aspects: A review.

Heart valve diseases are a prevalent cardiovascular pathology worldwide, affecting nearly 2.5% of the population. Degenerative aortic stenosis is the most common form of heart valve disease. The treatment options include surgical or transcatheter procedures. There are two main categories of valve prostheses available: mechanical heart valves constructed from synthetic materials and bioprosthetic heart valves made from natural biomaterials. The choice of valve type depends on various factors, including the underlying medical condition, suitability for anticoagulation, valve durability, and the patient's age and preferences. Mechanical heart valves have the advantage of long-term durability. However, patients receiving mechanical implants are subjected to lifelong anticoagulation therapy with an increased risk of thromboembolism and bleeding. Natural biomaterials do not require long-term anticoagulation. However, they experience degenerative changes leading to structural valve deterioration that may require reoperation. The purpose of this article is to review the role of natural biological materials used for aortic valve replacement or repair, assess their biomedical and clinical advantages and limitations, and analyze the direction and perspectives of future development.

Squamomelanocytic Tumor, An Entity Still Shrouded in Mystery: Case Report and Literature Review

Cutaneous squamomelanocytic tumor (SMT) is a very rare cutaneous malignancy, composed of a dual phenotypic population of both malignant melanocytes and keratinocytes, intimately intermingled together. Herein, we report a new case of a SMT occurring in an 82-year-old man, located on the scalp. Histopathology revealed a mixed population consisting of squamous cell carcinoma and melanoma within the same lesion, also confirmed using immunohistochemical staining for high molecular-weight cytokeratins (HMWCKs) and Melan-A. Moreover, to the best of our knowledge, for the first time, we tested SMT for the preferentially expressed antigen in melanoma (PRAME), which revealed a strong and diffuse positivity in the melanocytic component. These tumors need to be distinguished by more frequent collision tumors and colonization. Furthermore, we provide a comprehensive review of the literature, focusing on clinical and histopathological aspects, biological behavior and still-debated, but fascinating histogenesis of this elusive entity.

Lived experiences of people with chronic kidney disease on maintenance dialysis: a systematic review and thematic synthesis of qualitative studies

AimChronic Kidney Disease (CKD) has emerged as a global public health concern. People with the most advanced stage of CKD require renal replacement therapies, either dialysis (the focus of this study) or a kidney transplant. Research on CKD has primarily focused on its clinical, epidemiological, and public health aspects. However, studies exploring the lived experiences of individuals on dialysis and the key factors influencing these experiences are limited, particularly in low- and middle-income settings. Therefore, this study aims to synthesize the existing literature on the illness experience of people living with CKD who are on maintenance dialysis across different country contexts.MethodsAdhering to PRISMA and PiCO guidelines for systematic review, we identified original studies published between 2000 and 2024, focusing on the lived experience of patients with CKD on dialysis, across PubMed, Web of Science, and Scopus databases. A thematic analysis was conducted based on two frameworks: Michael Bury’s biographical disruption model of chronic illness, and the framework on internal and external factors affecting self-care.ResultsA total of 59 studies were included, and the following key themes were identified: 1) disrupted biographies among people on dialysis, which included: (a) diagnosis and initiation of dialysis, (b) disabling physical symptoms and functional limitations, (c) impaired socio-occupational functioning, (d) uncertainty and psychological distress, and (e) changes in self-image and identity; and 2) biographical repair, which included: (a) coping with CKD and dialysis, (b) coping styles, and (c) coping strategies. The key internal factors influencing the lived experiences were personal beliefs and misconceptions about CKD, feelings of shame and guilt, financial constraints, and spirituality. The external factors included family and social support, information and treatment received from the clinical team, social stigma, availability and quality of dialysis services, and access to health insurance.ConclusionsThis review deepens our understanding of the lived experiences of individuals undergoing maintenance dialysis across diverse settings and illuminates the internal and external factors that shape these experiences. Our findings emphasize the necessity of a holistic and person-centred approach to dialysis care and highlight the need to make dialysis services more accessible and affordable in low- and lower-middle-income countries.

Exploring Chemoprevention in Colorectal Cancer for Patients with Inflammatory Bowel Disease: Mechanisms of Action and Clinical Aspects.

Background: Inflammatory bowel diseases (IBDs) have been associated with a higher risk of colorectal cancer (CRC) development and chronic colonic inflammation seems to have a critical role in the pathogenesis of CRC in patients suffering from IBD. In respect to that, surveillance colonoscopy at regular intervals is recommended in patients with colitis. Objective: This review aims to explore the chemopreventive potential of a range of agents, including mesalazine, thiopurines, anti-TNF agents, statins, ursodeoxycholic acid, aspirin, folic acid, and nutraceuticals. Results: These agents target inflammation, oxidative stress, and oncogenic pathways, thereby offering the potential to reduce the risk of CRC in patients with IBD. Anti-TNF agents, such as infliximab and adalimumab, not only reduce colonic inflammation, but also play a protective role against CRC by lessening the carcinogenic effects associated with prolonged inflammatory processes. Furthermore, mesalazine and thiopurines have demonstrated established efficacy, while newer biologics, including interleukin inhibitors, show promising advancements. Although nutraceuticals and dietary interventions require further clinical validation, they offer additional possibilities for non-pharmacological prevention. Conclusion: Despite progress, knowledge gaps persist regarding the long-term safety, optimal dosing, and combined use of these agents. A significant reduction in the incidence of CRC in patients with IBD could be achieved by advancing chemoprevention and personalizing strategies.

Scorpionism in the State of Bahia, Brazil: A More Neglected Problem During the Pandemic?

During the confinement in the COVID-19 pandemic, there was an increase in the production of urban waste, increasing the risk of accidents caused by scorpions. We sought to determine the clinical and epidemiologic aspects of scorpionism records in the 7 mesoregions of the State of Bahia, Brazil, examining differences in periods before and during the pandemic. Data were obtained from SINAN, Brazil's Notifiable Diseases Information System (January 2010-December 2021). Measures of morbidity (incidence and lethality) and mortality were evaluated, comparing the averages before (2018 and 2019) and during the pandemic (2020 and 2021). Sociodemographic data (ie, gender, age group, and race) and conditions of care (ie, time, classification, and evolution) were compared by mesoregion. A total of 159,982 cases of scorpionism were registered, with a higher proportion in the prepandemic period (P<0.05) and a higher average incidence in the Center South of Bahia (267.32; n=82,059; 51.29%). Most cases occurred in mixed-race individuals (61.73%), females (n=81,292; 51.22%), and individuals between 20 and 39 y of age (n=48,876; 30.55%) and most cases were classified as mild (n=136,816; 85.52%), were attended in <1 h (n=81,941; 51.22%), and progresses to cure (n=142,082; 88.81%). There were 263 deaths (0.16%), with a mortality rate of 1.77/100,000 inhabitants and a lethality of 0.16%. It is suggested that during the COVID-19 pandemic, despite the upward curve of accidents, social isolation measures and collective fear may have decreased the search for medical care after a scorpion sting, reducing notifications of the condition in the State of Bahia.

Chronic Spontaneous Urticaria After New Coronavirus Infection: Clinical Cases

Background. Inefficacy of conventional chronic spontaneous urticaria (CSU) treatments significantly reduces patients’ quality of life. Data on CSU (triggered by new coronavirus infection) prevalence and course in children is very limited.Clinical case description. Authors have presented three clinical cases of CSU onset after the new coronavirus infection. Clinical features of disease and targeted therapy efficacy were evaluated.Conclusion. The course of CSU, potentially triggered by SARS-CoV-2, has its own features, and requires larger research with the study of clinical and laboratory aspects, as well as the immunological mechanisms underlying the disease, with revealing biomarkers indicating disease severity, course, and prognosis.

Infective endocarditis caused by Gemella – a retrospective registry-based study

Purpose Infective endocarditis (IE) is diagnosed using the Duke criteria, which were updated in 2023. In the Duke-ISCVID 2023 criteria, Gemella was recognised as a typical IE pathogen. This study investigates the impact of this change and compares the clinical characteristics of Gemella IE to IE caused by other pathogens. Methods Data on IE caused by Gemella species and other pathogens was retrieved from the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of Gemella IE were compared to episodes of IE caused by non-beta haemolytic streptococci, by Staphylococcus aureus and by enterococci. Results In the SRIE, 29 episodes of Gemella IE were identified among a total of 7677 registered episodes, corresponding to 0.4% of all cases. The most common species were Gemella morbillorum (47%) and Gemella bergerii (27%). The proportion of episodes meeting the criteria for definite IE increased from 13 (45%) with the modified Duke criteria to 21 (72%) with the Duke-ISCVID criteria. Median age of patients with Gemella IE was 70 years, 40% were females and 90% hade native valve IE. One third of the patients underwent heart valve surgery and only one patient (3%) died. Many clinical aspects of IE caused by Gemella resembled those of IE caused by non-beta haemolytic streptococci. Conclusions Gemella IE is a rare condition and shares several characteristics with IE caused by non-beta haemolytic streptococci. The prognosis of IE caused by Gemella appears to be relatively favourable.

A potential therapeutic approach for ulcerative colitis: targeted regulation of mitochondrial dynamics and mitophagy through phytochemicals.

Mitochondria are important organelles that regulate cellular energy and biosynthesis, as well as maintain the body's response to environmental stress. Their dynamics and autophagy influence occurrence of cellular function, particularly under stressful conditions. They can generate reactive oxygen species (ROS) which is a major contributor to inflammatory diseases such as ulcerative colitis (UC). In this review, we discuss the key effects of mitochondrial dynamics and mitophagy on the pathogenesis of UC, with a particular focus on the cellular energy metabolism, oxidative stress, apoptosis, and immunoinflammatory activities. The therapeutic efficacy of existing drugs and phytochemicals targeting the mitochondrial pathway are discussed to reveal important insights for developing therapeutic strategies for treating UC. In addition, new molecular checkpoints with therapeutic potential are identified. We show that the integration of mitochondrial biology with the clinical aspects of UC may generate ideas for enhancing the clinical management of UC.